Pre-emptive analgesia of ultrasound-guided pectoral nerve block II with dexmedetomidine–bupivacaine for controlling chronic pain after modified radical mastectomy

Hassn, Ali M Ali; Zanfaly, Hala E; Biomy, Taha

doi:10.4103/2356-9115.184078

Cited by 27 publications

(34 citation statements)

References 1 publication

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“…A recent meta‐analysis concluded that PECS‐2 block reduced postoperative pain and analgesic dose during the first 24 h after breast surgery . The five trials that included women scheduled for radical mastectomy were prone to performance bias or reporting bias . None of these trials used a multimodal analgesic regimen.…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

et al. 2019

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Summary We randomly allocated 50 women scheduled for radical mastectomy to pectoral nerves‐2 (PECS‐2) block (n = 25) or no block (n = 25), 20 and 22 of whom we analysed for the primary outcome of a cumulative 24‐h postoperative morphine dose. We gave intra‐operative sufentanil, magnesium, dexamethasone and droperidol. Participants received regular postoperative paracetamol, ibuprofen and patient‐controlled intravenous morphine. Pectoral nerves‐2 block reduced mean (SD) cumulative 24 h postoperative morphine dose from 9.7 (8.9) mg to 5.0 (5.4) mg and 48 h morphine dose from 12.8 (12.5) mg to 6.0 (6.5) mg, p = 0.04 for both. The mean (SD) pain scores 24 h and 48 h after surgery were similar with or without block: 0.8 (1.4) vs. 1.2 (1.9), p = 0.39; and 0.2 (0.4) vs. 0.9 (1.8), p = 0.09, respectively. Rates of postoperative nausea, vomiting and pruritus were unaffected. Rates of chronic pain at six postoperative months were 2/19 and 2/18 after block and no block, respectively, p = 0.95.

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Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

et al. 2019

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“…They noted that lower VAS scores in the first 24 h after surgery, reduced chronic pain on follow up, and better patient satisfaction. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Nagaraja¹,

Arasu²,

Ragavendran³

et al. 2020

Ann Card Anaesth

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Background: Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods: Thirty adult patients between the age group of 18–85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block ( n = 15) or Group PT: PECS1 and TTM blocks ( n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results: VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure ( P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT ( P = 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT ( P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT ( P = 0.0003). Conclusion: Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.

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“…Ali Hassn et al . [ 12 ] in their study on ultrasound-guided Pecs block with the use of dexmedetomidine and bupivacaine for controlling chronic pain after MRM observed and concluded that reduced VAS scores were seen at the first 24 h postoperatively, with significant reduction in total postoperative analgesia and delayed rescue analgesia in the bupivacaine-dexmedetomidine group in relation to the control group. This marked reduction in the severity of postoperative pain correlated with reduced chronic pain on follow-up and better patient satisfaction, good sleep, and reduced analgesic requirement, which improved quality of life.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

et al. 2018

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Background:Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique.Aims:We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia.Materials and Methods:Forty adult patients between the age groups of 25 and 65 years undergoing coronary artery bypass grafting or valve surgeries through midline sternotomy under general anesthesia were enrolled in the study. Patients were randomly allocated into two groups with 20 in each group. Group 1 patients did not receive Pecs block, whereas Group 2 patients received bilateral Pecs block postoperatively. Patients were extubated once they fulfilled extubation criteria. Ventilator duration was recorded. Patients were interrogated for pain by visual analog scale (VAS) scoring at rest and cough. Inspiratory flow rate was assessed using incentive spirometry.Results:Pecs group patients required lesser duration of ventilator support (P < 0.0001) in comparison to control group. Pain scores at rest and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were comparable between two groups. Peak inspiratory flow rates were higher in Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05). Thirty-four episodes of rescue analgesia were given in control group, whereas in Pecs group, there were only four episodes of rescue analgesia.Conclusion:Pecs block is technically simple and effective technique and can be used as part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and outcome.

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Pre-emptive analgesia of ultrasound-guided pectoral nerve block II with dexmedetomidine–bupivacaine for controlling chronic pain after modified radical mastectomy

Cited by 27 publications

References 1 publication

A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

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